Preventive Services
Published 09/18/2024
No, providers may not bill Medicare Part B for administering Part D vaccines.
Resource: CMS MLN Medicare Part D Vaccines Fact Sheet.
Last Reviewed: 9/18/2024
No, shingles vaccines are not covered under Part B Medicare. The shingles (herpes zoster) vaccine is a preventive vaccine that can be covered by Part D Medicare. Contact the patient’s Medicare Part D plan to verify their coverage of the shingles vaccine.
Last Reviewed: 9/18/2024
Yes. Railroad Medicare covers CPT® code 90714 and CPT® code 90715 for tetanus antitoxin or booster vaccines when the vaccine is directly related to the treatment of an injury or direct exposure to a disease or condition. Medicare does not cover routine tetanus booster shots in the absence of injury or direct exposure.
Last Reviewed: 9/18/2024
| Preventive Immunization | HCPCS Code |
|---|---|
| Influenza Virus Vaccine | G0008 |
| Pneumococcal Vaccine | G0009 |
| Hepatitis B Vaccine | G0010 |
CPT® codes 90471 and 90472 will be denied when billed as the administration code for a preventive immunization that has been assigned a specific administration code.
For more information on billing preventive immunizations, see the CMS Medicare Preventive Services Tool.
Last Reviewed: 9/18/2024
Medicare Part B covers the following immunizations:
- Hepatitis B vaccine (for patients at high or intermediate risk)
- Influenza virus vaccine
- Pneumococcal pneumonia vaccine
- COVID-19 vaccine
- Vaccines directly related to the treatment of an injury or direct exposure to a disease or condition
Resources
- CMS IOM Pub.100-02, Medicare Benefit Manual, Chapter 15, Section 50.4.4.2, Immunizations (PDF)
- Medicare Preventive Services Tool
Last Reviewed: 9/18/2024
Except for vaccines covered under Medicare Part B, Medicare Part D plans generally cover all commercially available vaccines as long as the vaccine is reasonable and necessary to prevent illness. This includes preventive shingles (herpes zoster) vaccines and TDAP vaccines.
Part D plans may have special rules, such as prior authorization, step therapy and quantity limits. Contact your patient’s plan to find out about coverage.
Resource: CMS MLN Medicare Part D Vaccines Fact Sheet.
Last Reviewed: 9/18/2024
The CMS MLN Medicare Preventive Services Educational Tool includes coding, coverage, frequency, and what the beneficiary pays for Medicare covered preventive services.
Last Reviewed: 9/18/2024